Exploring Primary Care Clinicians’ Views about How Best to Implement a Potential Trial around Point-of-Care Tests for Common Infections in South Africa
Abstract
:1. Introduction
2. Methods
2.1. Participants
2.2. Interviews
2.3. Analysis
2.4. Reflexivity
3. Results
3.1. Theme 1. Clinicians’ Views about Proposed Trial Design and POCTs
“You know something like this could make a big change in a clinic […] like this. You know, money-saving and treating [infections] appropriately.”(P12)
“We have got such [high] HIV and TB problems that we also need to focus on.”(P1)
3.2. Theme 2. Clinicians’ Perspectives about Trial Set-Up
“I think [you should] take a 24 h [facility], a small facility like this and then […] in between facilities. Between the small and the big ones. Then you will […] see how [POCTs are] actually going to work for the small, medium and large [facilities].”(P7)
“Because that’s where we send everyone for […] special [investigations], like [urine] dipsticks or [rapid] HIV [tests], we send them to the prep [room].”(P12)
“You just mentioned there will be a tester […], so less time consuming for us. Definitely that will be a plus for the trial.”(P21)
“The person is going to wait [in the triage room] anyway, because they’re getting their blood pressure done […] they’re not going to immediately go and see a clinician anyway.”(P16)
3.3. Theme 3. Clinicians’ Perspectives on Trial Procedures
“The community members are already used to the ideas of [being] participants […]. They have been there, done that.”(P3)
“I can’t see a big issue particularly with that […], it is a big enough clinic that there would be enough patients to be a random sample.”(P5)
“It’s just the patient expectations […], they will be coming thinking [they are] getting a test and then they [are] not.”(P9)
“It can be very difficult to find [the patient file] if it was not put in the right place or not filed at all.”(P3)
“I would suggest [trying] to make some copies of [trial notes] […] or otherwise the [record] just literally goes missing.”(P4)
“Patients that I am really worried about, I would rather just give them a date, then I write my name on it and I tell them you come back to me.”(P6)
“A lot of [patients] change their cell phone numbers every three or four months.”(P9)
“So if we want someone, there is a pamphlet where it says Mrs. […] you are required to come to the clinic and then our community care workers will drop at the house and then the patient comes.”(P10)
“They just expect to be treated well when they come, so it is kind of like incentives, we will go and, we will fast-track their medication [when they attend clinic].”(P3)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Interview Topic Guide
- Firstly, what do you think of the idea of the trial?
- Prompt—Do you think such a trial is achievable?
- How do you think we should organise the recruitment of patients?
- Prompt—How should we select day hospitals for recruitment? Should this be based on geography, rates of antibiotic prescribing, size of the clinics? Where should we recruit patients?
- What would be a good way to randomise patients to the study?
- Prompt—For example, a computer system (not a doctor) will decide which patients will have POCTs before they are given treatment. How would such a system work in the clinic? Can we do this online or through a smartphone? Is there a private office available?
- How do you think we could organise POC testing in the day hospitals?
- Prompt—How many machines are needed? Where can the POCT be placed safely? How can we avoid it being used when patients are not being randomised to the POCT?
- How can we ensure that all the clinical information for the trial is properly recorded?
- Prompt—Is there a system to compare and check patient details?
- What would be the best way to follow-up patients?
- Prompt—How often are patients followed-up? Is there a separate clinic for follow-up patients?
- Patients will also require samples to be collected during the trial. How can we ensure that the correct samples are sent to a special research laboratory in Cape Town?
- Prompt—What happens to samples that are taken in the clinic? Where are they sent? How often are the collections?
Appendix B. Participant Characteristics
Participant | Site | Age | Gender | Race | Position | Years in Practice (*) |
---|---|---|---|---|---|---|
01 | Clinic A | 44 | Male | White South African | FP | 13 (7 since specialisation) |
02 | Clinic B | 48 | Male | Mixed race | FP | 24 (16) |
03 | Clinic C | 54 | Female | Black African | FP | 28 (20) |
04 | Clinic D | 32 | Male | Mixed race | FP | 10 (2) |
05 | Clinic E | 43 | Male | White South African | FM SpR | 12 (7) |
06 | Clinic F | 31 | Female | Mixed race | NP | 7 (3) |
07 | Clinic F | 55 | Female | Mixed race | NP | 39 (20) |
08 | Clinic F | 47 | Female | Mixed race | NP | 23 (10) |
09 | Clinic F | 35 | Female | White South African | MO | 11 (0) |
10 | Clinic F | 31 | Female | Black African | NP | 7 (0) |
11 | Clinic F | 49 | Female | Mixed race | NP | 28 (15) |
12 | Clinic G | 33 | Female | White South African | FP | 10 (3) |
13 | Clinic H | 37 | Female | White South African | FP | 14 (4) |
14 | Clinic E | 39 | Male | Mixed race | MO | 16 (2) |
15 | Clinic I | 39 | Female | Mixed race/coloured | FP | 15 (4) |
16 | Clinic F | 46 | Male | White South African | FP | 21 (6) |
17 | Clinic J | 42 | Male | Mixed race/coloured | NP | 18 (11) |
18 | Clinic J | 38 | Female | Black African | NP | 10 (10) |
19 | Clinic J | 53 | Female | White South African | NP | 33 (20) |
20 | Clinic K | 49 | Female | White South African | FP | 26 (10) |
21 | Clinic L | 36 | Male | Black African | MO | 13 (0) |
22 | Clinic G | 41 | Male | Black African | MO | 15 (0) |
23 | Clinic M | 48 | Female | White South African | FP | 24 (17) |
References
- Costelloe, C.; Metcalfe, C.; Lovering, A.; Mant, D.; Hay, A.D. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: Systematic review and meta-analysis. BMJ Open 2010, 340, c2096. [Google Scholar] [CrossRef] [Green Version]
- Bell, B.G.; Schellevis, F.; Stobberingh, E.; Goossens, H.; Pringle, M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect. Dis. 2014, 14, 13. [Google Scholar] [CrossRef] [Green Version]
- van Hecke, O.; Wang, K.; Lee, J.J.; Roberts, N.W.; Butler, C.C. Implications of antibiotic resistance for patients’ recovery from common infections in the community: A systematic review and meta-analysis. Clin. Infect. Dis. 2017, 65, 371–382. [Google Scholar] [CrossRef] [PubMed]
- Dolk, F.C.K.; Pouwels, K.B.; Smith, D.R.M.; Robotham, J.V.; Smieszek, T. Antibiotics in primary care in England: Which antibiotics are prescribed and for which conditions? J. Antimicrob. Chemother. 2018, 73, ii2–ii10. [Google Scholar] [CrossRef]
- Fleming-Dutra, K.E.; Hersh, A.L.; Shapiro, D.J.; Bartoces, M.; Enns, E.A.; File, T.M., Jr.; Finkelstein, J.A.; Gerber, J.S.; Hyun, D.Y.; Linder, J.A.; et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 2016, 315, 1864–1873. [Google Scholar] [CrossRef] [Green Version]
- Shapiro, D.J.; Hicks, L.A.; Pavia, A.T.; Hersh, A.L. Antibiotic prescribing for adults in ambulatory care in the USA, 2007–2009. J. Antimicrob. Chemother. 2014, 69, 234–240. [Google Scholar] [CrossRef] [Green Version]
- Lucas, P.J.; Cabral, C.; Hay, A.D.; Horwood, J. A systematic review of parent and clinician views and perceptions that influence prescribing decisions in relation to acute childhood infections in primary care. Scand. J. Prim. Health Care 2015, 33, 11–20. [Google Scholar] [CrossRef] [PubMed]
- Tonkin-Crine, S.K.G.; Tan, P.S.; van Hecke, O.; Wang, K.; Roberts, N.W.; McCullough, A.; Hansen, M.P.; Butler, C.C.; Del Mar, C.B. Clinician-targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: An overview of systematic reviews. Cochr. Database Syst. Rev. 2017, 9, CD012252. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Van Hecke, O.; Raymond, M.; Lee, J.J.; Turner, P.; Goyder, C.R.; Verbakel, J.Y.; Van den Bruel, A.; Hayward, G. In-vitro diagnostic point-of-care tests in paediatric ambulatory care: A systematic review and meta-analysis. PLoS ONE 2020, 15, e0235605. [Google Scholar] [CrossRef]
- Escadafal, C.; Incardona, S.; Fernandez-Carballo, B.L.; Dittrich, S. The good and the bad: Using C reactive protein to distinguish bacterial from non-bacterial infection among febrile patients in low-resource settings. BMJ Glob. Health 2020, 5, e002396. [Google Scholar] [CrossRef]
- Center for Disease Dynamics Economics and Policy. State of the World’s Antibiotics, 2015; Center for Disease Dynamics Economics and Policy: Silver Spring, MA, USA, 2015. [Google Scholar]
- Van Boeckel, T.P.; Gandra, S.; Ashok, A.; Caudron, Q.; Grenfell, B.T.; Levin, S.A.; Laxminarayan, R. Global antibiotic consumption 2000 to 2010: An analysis of national pharmaceutical sales data. Lancet Infect. Dis. 2014, 14, 742–750. [Google Scholar] [CrossRef]
- Gasson, J.; Blockman, M.; Willems, B. Antibiotic prescribing practice and adherence to guidelines in primary care in the Cape Town Metro District, South Africa. S. Afr. Med. J. 2018, 108, 304–310. [Google Scholar] [CrossRef]
- van Hecke, O.; Butler, C.; Mendelson, M.; Tonkin-Crine, S. Introducing new point-of-care tests for common infections in publicly funded clinics in South Africa: A qualitative study with primary care clinicians. BMJ Open 2019, 9, e029260. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Elfil, M.; Negida, A. Sampling methods in clinical research. An educational review. Emerg 2017, 5, e52. [Google Scholar]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef] [Green Version]
- Botes, A.S.; Majikela-Dlangamandla, B.; Mash, R. The ability of health promoters to deliver group diabetes education in South African primary care. Afr. J. Prim. Health Care Fam. Med. 2013, 5, 484. [Google Scholar] [CrossRef] [Green Version]
- Stassen, W.; Wallis, L.; Castren, M.; Vincent-Lambert, C.; Kurland, L. A prehospital randomised controlled trial in South Africa: Challenges and lessons learnt. Afr. J. Emerg. Med. 2019, 9, 145–149. [Google Scholar] [CrossRef]
- Marks, M.; Esau, T.; Asugeni, R.; Harrington, R.; Diau, J.; Toloka, H.; Asugeni, J.; Ansbro, E.; Solomon, A.W.; Maclaren, D.; et al. Point-of-care tests for syphilis and yaws in a low-income setting-A qualitative study of healthcare worker and patient experiences. PLoS Negl. Trop. Dis. 2018, 12, e0006360. [Google Scholar] [CrossRef] [Green Version]
- Pai, N.P.; Wilkinson, S.; Deli-Houssein, R.; Vijh, R.; Vadnais, C.; Behlim, T.; Steben, M.; Engel, N.; Wong, T. Barriers to implementation of rapid and point-of-care tests for human immunodeficiency virus infection: Findings from a systematic review (1996–2014). Point Care 2015, 14, 81–87. [Google Scholar] [CrossRef] [Green Version]
- Eley, C.V.; Sharma, A.; Lecky, D.M.; Lee, H.; McNulty, C.A.M. Qualitative study to explore the views of general practice staff on the use of point-of-care C reactive protein testing for the management of lower respiratory tract infections in routine general practice in England. BMJ Open 2018, 8, e023925. [Google Scholar] [CrossRef] [Green Version]
- Brueton, V.C.; Tierney, J.; Stenning, S.; Harding, S.; Meredith, S.; Nazareth, I.; Rait, G. Strategies to improve retention in randomised trials. Cochr. Database Syst. Rev. 2013, 2013, MR000032. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Brueton, V.C.; Stevenson, F.; Vale, C.L.; Stenning, S.P.; Tierney, J.F.; Harding, S.; Nazareth, I.; Meredith, S.; Rait, G. Use of strategies to improve retention in primary care randomised trials: A qualitative study with in-depth interviews. BMJ Open 2014, 4, e003835. [Google Scholar] [CrossRef] [Green Version]
- Galárraga, O.; Harries, J.; Maughan-Brown, B.; Cooper, D.; Short, S.E.; Lurie, M.N.; Harrison, A. The Empower Nudge lottery to increase dual protection use: A proof-of-concept randomised pilot trial in South Africa. Reprod. Health Matters 2018, 26, 1510701. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wagstaff, A.; van Doorslaer, E.; Burger, R. SMS nudges as a tool to reduce tuberculosis treatment delay and pretreatment loss to follow-up. A randomized controlled trial. PLoS ONE 2019, 14, e0218527. [Google Scholar] [CrossRef] [Green Version]
- Bobrow, K.; Farmer Andrew, J.; Springer, D.; Shanyinde, M.; Yu, L.-M.; Brennan, T.; Rayner, B.; Namane, M.; Steyn, K.; Tarassenko, L.; et al. Mobile phone text messages to support treatment adherence in adults with high blood pressure (SMS-text adherence support [StAR]). Circulation 2016, 133, 592–600. [Google Scholar] [CrossRef] [Green Version]
- Domek, G.J.; Contreras-Roldan, I.L.; O’Leary, S.T.; Bull, S.; Furniss, A.; Kempe, A.; Asturias, E.J. SMS text message reminders to improve infant vaccination coverage in Guatemala: A pilot randomized controlled trial. Vaccine 2016, 34, 2437–2443. [Google Scholar] [CrossRef]
- Odeny, T.A.; Bailey, R.C.; Bukusi, E.A.; Simoni, J.M.; Tapia, K.A.; Yuhas, K.; Holmes, K.K.; McClelland, R.S. Text messaging to improve attendance at post-operative clinic visits after adult male circumcision for HIV prevention: A randomized controlled trial. PLoS ONE 2012, 7, e43832. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Husbands, S.; Caskey, F.; Winton, H.; Gibson, A.; Donovan, J.L.; Rooshenas, L. Pre-trial qualitative work with health care professionals to refine the design and delivery of a randomised controlled trial on kidney care. Trials 2019, 20, 224. [Google Scholar] [CrossRef]
Theme 1. Clinicians’ views about proposed trial design and POCTs |
1.1 Optimism for proposed trial design and novel POCTs 1.2 Considerations for trial design 1.3 Experiences of other trials 1.4 Previous experiences of POCTs influence clinicians’ perceptions of new POCTs |
Theme 2. Clinicians’ perspectives about trial set-up |
2.1 Differing opinions about inclusion of trial sites (clinics) 2.2 Available space varies and may be either a barrier or facilitator of trial 2.3 POCTs in patient flow |
Theme 3. Clinicians’ perspectives on trial procedures |
3.1 Clinicians identified many ways to recruit patients and few barriers to recruitment 3.2 Randomisation of patients to trial 3.3. Process of sample collection and results 3.4 Available technology at clinic sites is limited so patient notes are paper-based 3.5 Follow-up procedure varies between clinics 3.6 Barriers to follow-up in trial 3.7 Facilitators to follow-up, and suggestions to improve follow-up in trial |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Epps, A.; Albury, C.; Van Hecke, O. Exploring Primary Care Clinicians’ Views about How Best to Implement a Potential Trial around Point-of-Care Tests for Common Infections in South Africa. Diagnostics 2021, 11, 2100. https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11112100
Epps A, Albury C, Van Hecke O. Exploring Primary Care Clinicians’ Views about How Best to Implement a Potential Trial around Point-of-Care Tests for Common Infections in South Africa. Diagnostics. 2021; 11(11):2100. https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11112100
Chicago/Turabian StyleEpps, Alice, Charlotte Albury, and Oliver Van Hecke. 2021. "Exploring Primary Care Clinicians’ Views about How Best to Implement a Potential Trial around Point-of-Care Tests for Common Infections in South Africa" Diagnostics 11, no. 11: 2100. https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics11112100